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Research Article: Experience of patients and physiotherapists within the AFTER pilot randomised trial of two rehabilitation interventions for people aged 50 years and over post ankle fracture: a qualitative study

Date Published: 2023-07-24

Abstract:
Objectives To explore patient and staff experience of best-practice rehabilitation advice (one session of face-to-face self-management advice with up to two additional optional sessions) compared with progressive functional exercise (up to six sessions of face-to-face physiotherapy) after ankle fracture. Design The study drew on phenomenology using interviews and a focus group. Setting Participants were from three NHS Trusts in England, UK. Participants A purposive sample of 20 patients with ankle (malleolar) fractures from the Ankle Fracture Treatment: Enhancing Rehabilitation-pilot trial (now completed) were interviewed (median 50?min) from May 2019 to January 2020. They were 6 months post injury, over 50 years of age, (median 66, 12 females) and had received surgical or non-surgical treatment (seven internal fixation surgery, seven close contact casting, six walking boot). A focus group of five physiotherapists who had provided the study interventions (2.5?hours) was undertaken. Results The findings show the acceptability of both interventions through the themes, ‘being helped’ (for patients) and ‘developing expertise’ (for staff) with subthemes of choosing and progressing. Progressive exercise added value with a perceived increase in strength, motion, ability to undertake activities and continued use of the workbook. Both staff and patients valued physiotherapy expertise demonstrated through interpersonal skills, advice, individualised exercise plans and active monitoring of progression. Best practice advice was particularly helpful in the early stages of recovery and with the use of mobility aids. Conclusion Both interventions were acceptable but progressive exercise was highly valued by patients. Developing expertise through experiential learning enabled staff to facilitate progression. Adjustments to the workbook and the addition of exercises for continued recovery in the best practice advice would enhance a future study. Research during treatment provision may provide further insights into the challenges of facilitating progression of exercise. Trial registration ISRCTN16612336; AFTER-pilot trial).

Introduction:
Ankle fractures represent about 1 in 10 of all fractures managed in UK hospitals. 1 Peak incidence is in women aged 60–70, 2 usually after a fall from standing height, so most are considered fragility fractures. 3 People who sustain a stable ankle fracture typically have a period of immobilisation in a cast or walking boot and weightbearing and/or ankle movement restrictions. Those with more severe ankle fractures undergo surgery followed by the same immobilisation, weight-bearing and/or movement restrictions.…

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